Testicular tumors

Disease Description (Causes and Symptoms)

• Definition summary: Testicular tumors are tumors that arise in the testes and are mainly divided according to their origin into germ cell tumors (approximately 95%) and non-germ-cell (sex cord-stromal) tumors (approximately 5–6%).
• Pathophysiology summary: Germ cell tumors originate from stages of differentiation of normal germ cells (seminoma or non-seminoma: embryonal carcinoma, yolk sac tumor, choriocarcinoma, teratoma, etc.). Non-germ-cell tumors arise from Leydig cells, Sertoli cells, and other cells.
• Main causes/associated factors: The exact cause is unknown. They are associated with congenital and acquired factors, particularly cryptorchidism, which is an important risk factor.
• Representative symptoms: A painless testicular mass (a lump that slowly enlarges), scrotal discomfort, swelling of the scrotum or genitalia, and, in some cases, acute pain (when internal bleeding or infarction occurs). If metastasis occurs to the lymph nodes, lungs, bones, or other sites, symptoms of the affected area may appear, such as back pain, coughing/shortness of breath, or bone pain.
• Diagnostic supporting findings: Serum tumor markers (AFP, β‑hCG, LDH) and scrotal ultrasonography are essential; abdominal/pelvic CT and chest imaging are needed to evaluate metastasis.

Treatment Methods

• Standard principles: After diagnosis, radical inguinal orchiectomy is the initial treatment and the means of confirming the diagnosis. Subsequent treatment (surveillance, radiotherapy, chemotherapy, retroperitoneal lymph node dissection, etc.) is determined according to the pathology, stage, and tumor markers.
• Summary of germ cell tumors (seminoma vs non-seminoma):
  • Seminoma
    • Stage I (low risk): Surveillance after orchiectomy or selective low-dose retroperitoneal radiotherapy. The 5-year survival rate is very high (approximately 98%, with differences depending on the treatment method and the patient's condition).
    • Stage II/III (lymph node or distant metastasis): Radiotherapy or chemotherapy after orchiectomy, selected according to the size and extent of the lesions (depending on tumor size and degree of metastasis).
    • If recurrence occurs or tumor markers remain positive, chemotherapy or surgical removal may be considered.
  • Non-seminoma
    • Stage I: Retroperitoneal lymph node dissection (RPLND) or surveillance/adjuvant chemotherapy after orchiectomy. 5-year survival rate >90%.
    • Stage II/III: Orchiectomy + RPLND ± systemic chemotherapy. If a residual mass remains, surgical removal is performed.
• Chemotherapy: Cisplatin-based combination therapy is typically used widely as the first-line standard treatment (e.g., BEP: Bleomycin, Etoposide, Cisplatin), with the number of cycles and combination adjusted according to stage and risk.
• Non-germ-cell tumors (Leydig, Sertoli, etc.): Radical orchiectomy is the first-line treatment in most cases. If malignant features are present, retroperitoneal lymph node dissection is added. The effects of chemotherapy and radiotherapy may be limited.
• Fertility and hormone management: Sperm banking is recommended before treatment, particularly when chemotherapy is planned. If long-term hormone deficiency or impaired testicular function is a concern, endocrine follow-up and testosterone replacement may be considered.
• Lifestyle management/precautions: Manage infections and wounds before and after treatment, monitor adverse effects of anticancer drugs such as hematologic toxicity and respiratory toxicity, and comply with regular follow-up examinations (tumor markers and imaging).

Checklist Before an Outpatient Visit (Including Example Questions)

• Items to prepare/submit
  • A list of currently used medications, including prescriptions, OTC medications, and supplements
  • Past surgeries, hospitalizations, and medical history (especially cryptorchidism and whether sperm has been banked)
  • Copies of previous test results (scrotal ultrasonography, serum tumor markers AFP/β‑hCG/LDH, CT, X-ray, etc.)
  • A record of symptom changes (changes in lump size, pain, fever, respiratory symptoms, back pain, or other symptoms of metastasis)
  • Plans related to fertility (desire to have children and whether sperm banking is desired)
• Information to tell the medical staff in advance during the outpatient visit
  • Recent fever or symptoms of infection, shortness of breath, or a tendency to bleed
  • Allergies, including drug allergies, and pregnancy-related information (regarding the partner)

General Example Questions to Ask the Doctor

• "What is the classification of my stage, and what is the standard treatment recommendation based on it?"
• "What type of chemotherapy is recommended, and what side effects can be expected?"
• "How will treatment affect fertility (the possibility of pregnancy), and is sperm banking necessary?"
• "What is the schedule for follow-up examinations after treatment (tumor markers and imaging)?"

Examples of Disease-Specific Questions

• "How should my serum tumor marker levels (AFP, β‑hCG, LDH) be interpreted, and what significance do they have for determining treatment?"
• "After surgery (radical orchiectomy), how will the function of the contralateral testis and long-term hormone management be addressed?"

Additional guidance: Decisions regarding diagnosis and treatment should be made in consultation with specialists (urology, medical oncology, and radiation oncology), taking into account the stage, histologic type, general condition, and the patient's preferences. Prior consultation is recommended regarding sperm banking and the possibility of long-term complications of radiotherapy and anticancer drugs (such as cardiopulmonary function impairment and secondary cancers).